lunes, 31 de octubre de 2011

Perinatal Antidepressant May Affect Brain Development

Rats exposed to an antidepressant just before and after birth had altered behaviors and substantial brain abnormalities. The findings raise questions about how perinatal antidepressants might influence brain development in people.

The part of the brain that connects the left and right hemispheres shows abnormalities (right) in rats that received an antidepressant during a critical period around the time of birth.Source: Dr. Rick C.S. Lin, University of Mississippi Medical Center.

Serotonin—a chemical messenger in the brain—plays an important role in brain development. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) work by boosting serotonin activity in the brain. However, recent studies have found associations between women taking SSRIs during pregnancy and potential development problems in their offspring, including an increased risk for autism.
A team led by Dr. Rick Lin of the University of Mississippi Medical Center, Jackson, used rats as a model to investigate the effects of SSRIs on brain development. The scientists gave citalopram, an SSRI, to male and female rat pups prenatally and postnatally and examined their brains and behavior as they grew up. The work was supported by several NIH institutes, including the National Institute of Mental Health (NIMH). Results appeared online before print on October 24, 2011, in the Proceedings of the National Academy of Sciences.
The researchers found that long-distance connections between the 2 hemispheres of the brain showed stunted growth and degeneration. The animals also became excessively fearful when faced with new situations and failed to play normally with peers—behaviors reminiscent of autism.
The abnormalities were more pronounced in male than female rats, just as autism affects 3-4 times more boys than girls. Male, but not female, SSRI-exposed rat pups abnormally froze when they heard an unfamiliar tone and balked at exploring their environment in the presence of unfamiliar objects or scents. These behaviors persisted into adulthood. The male pups were also more likely to shun normal juvenile play behavior.
The brains of perinatally exposed animals showed evidence of neurons firing out of sync and other electrophysiological abnormalities. A key brain serotonin circuit called the raphe system showed evidence of stunted development. The raphe system is known to shape the developing brain during the critical period when the rat pups were exposed to the drug. The researchers also discovered problems in the structure responsible for communications between the brain's left and right hemispheres, called the corpus collosum. This damage was 3 times worse in male than in female pups.
“Our findings underscore the importance of balanced serotonin levels—not too high or low—for proper brain maturation,” Lin says.
“While one must always be cautious extrapolating from medication effects in rats to medication effects in people, these new results suggest an opportunity to study the mechanisms by which antidepressants influence brain and behavioral development,” says NIMH Director Dr. Thomas R. Insel. “These studies will help to balance the mental health needs of pregnant mothers with possible increased risk to their offspring.”

Yoga or Stretching Eases Low Back Pain

A new study reports that weekly classes of yoga or intensive stretching are equally effective at reducing low back pain and improving back movement. Both proved better than a self-care book, and their benefits lasted several months after the classes ended.

Each year, Americans spend over $50 billion on low back pain. It is the most common cause of job-related disability and a leading reason for missed work. A variety of treatments are available, but none have proved to be highly effective for chronic back pain. In addition, little is known about the comparative effectiveness of these therapies.
Several small studies have found that yoga may ease back pain. Based on ancient Indian philosophy, yoga has been practiced for more than 2,000 years. It typically combines physical postures, breathing techniques, and meditation or relaxation. Because it integrates both mind and body, some people suspect that yoga might be more beneficial than other exercise techniques in improving back pain. However, no studies have conclusively shown that yoga has this advantage.
To investigate, a team of researchers led by Dr. Karen J. Sherman of the Group Health Research Institute in Seattle launched a clinical trial that enrolled 228 adults. All had moderate low back pain that had lasted for at least 3 months. The study was funded by NIH's National Center for Complementary and Alternative Medicine (NCCAM).
Participants were randomly assigned to 1 of 3 groups. Two groups received 12 weekly 75-minute classes of either yoga (92 participants) or stretching exercises led by a licensed physical therapist (91 participants). Those taking yoga or stretching were asked to practice at home each non-class day for at least 20 minutes. The remaining 45 volunteers received a self-care book that described the causes of back pain and suggested exercise and lifestyle changes to reduce pain. The study results were reported in the October 24, 2011, advance online edition of the Archives of Internal Medicine.
The researchers found that after 3 months, the outcomes for the yoga group were better than those in the self-care group and continued to be better even at 6 months. The effectiveness of stretching was similar to yoga at 6 weeks, 3 months and 6 months. Compared to the self-care group, more yoga and stretching participants reduced their medication use for back pain. Those taking yoga or stretching classes also had better back functioning and were significantly more likely to rate their back pain as better or completely gone at all follow-up times.
“We expected back pain to ease more with yoga than with stretching, so our findings surprised us,” says Sherman. The similar effectiveness of the 2 exercise-based approaches suggests that the benefits of yoga for back pain may have less to do with the mental component than with the physical aspects of muscle stretching and strengthening.
“Our results suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain” Sherman says. She adds that it's important for classes to be taught by instructors who can tailor the difficulty and adjust stretches and postures to accommodate participants' physical limitations.
—by Vicki Contie

Pinpointing Kidney Disease Risk in African Americans

Variants in the APOL1 gene account for the increased risk of kidney disease among African Americans, according to a new report. The finding may lead to screening tests and earlier treatment, although further research is required.

When a person has kidney disease, the kidneys are unable to fully remove waste products and extra water from the blood. Long-term kidney disease hits the African American community especially hard, with rates up to 4 times higher than in European Americans.
In 2010, several NIH-funded research teams linked kidney disease risk to variants in a gene called APOL1. About 12% of African Americans have 2 copies of the APOL1 variants that increase the risk of kidney disease. These variants weren't found in people from other continents.
A research team led by Dr. Jeffrey Kopp at NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and Dr. Cheryl Winkler of NIH's National Cancer Institute (NCI) set out to do a comprehensive analysis of APOL1 variation in both African Americans and European Americans. The researchers studied a common kidney disease called focal segmental glomerulosclerosis (FSGS). FSGS often progresses to end-stage kidney disease and the need for dialysis or a kidney transplant. The researchers studied patients who came to the NIH Clinical Center and other collaborating medical centers.
In the October 13, 2011, online edition of the Journal of the American Society of Nephrology, the team reported that African Americans with 2 copies of the APOL1 variants have about a 4% lifetime risk of developing FSGS. Those with the variants who develop kidney disease tend to do so at younger ages than other FSGS patients.
African Americans who have HIV and 2 copies of the APOL1 variants also have a higher risk of developing HIV-associated nephropathy (HIVAN)—a type of kidney disease that develops in some people with HIV. People who fall into this category and are not being treated with anti-viral therapy have a 50% risk for developing HIVAN.
“These findings explain nearly all of the excess risk of non-diabetic kidney failure in African Americans. African Americans with no variant or 1 variant have about the same risk of end-stage kidney disease as their white counterparts,” Winkler says. “People with 2 APOL1 variants have greatly increased risk of particular kidney diseases—by 17- to 30-fold.”
“In the future, knowing that you have these gene variants and are at increased risk of developing kidney disease may tell you when to start screening for the disease and how to choose therapy,” Kopp says.
FSGS patients with 2 APOL1 variants respond as well to steroid treatments as those who don't have the variants, the researchers found. And anti-viral therapy appears fairly effective at preventing HIVAN. However, Kopp cautions that more research is needed to find out whether early genetic testing in the African American population would make a difference in eventual outcomes.

NIH scientists discover link among spectrum of childhood diseases
Hard-to-treat disorders characterized by inflammation and fat loss
An international collaboration of scientists, including researchers at the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health, has identified a genetic mutation that causes a rare childhood disease characterized predominantly by inflammation and fat loss. The research suggests that the disorder, named chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE), actually represents a spectrum of diseases that have been described in the literature under a variety of names. More importantly, since no effective treatment for this disease currently exists, the findings may have uncovered a possible target for future treatments.

The collaboration began when NIAMS rheumatologist Raphaela Goldbach-Mansky, M.D., started seeking the cause of inflammatory skin lesions, fat loss and fevers in two of her young patients. At a scientific meeting, she learned about recent publications by two other research groups — one led by dermatologists Antonio Torrelo, M.D., from the Boy Jesus Hospital, Madrid, and Amy Paller, M.D., from Northwestern University, Chicago, and the other led by Abraham Zlotogorski, M.D., from the Hadassah-Hebrew University Medical Center, Jerusalem — describing similar conditions. She immediately located the publications’ authors and emailed them that same night.

"It turned out they had found each other and were looking for a genetic cause and additional cases," said Dr. Goldbach-Mansky. "I contacted them with a case report with pictures and they sent me theirs."

Based on the clinical presentation and, particularly, the unusual skin lesions seen in the children, the researchers suspected that the children must have the same disease. Subsequent analyses — involving biopsies, blood tests and genetic testing — confirmed their suspicions. All but one child had at least one mutation in a gene called PSMB8, which had been recently identified in three adult patients with a disease called joint contractures, muscle atrophy and panniculitis-associated lipodystrophy (JMP).

PSMB8 is one of more than 20 components involved in making a cellular structure called a proteasome, which recycles proteins from cells that are stressed or dying.

"When the proteasome doesn't function, there is a buildup of protein waste products in the cells — much like if your trash wasn't picked up each week, it would accumulate in your driveway," said Dr. Goldbach-Mansky.

The one patient without the mutation had a blood profile that was identical to the ones who did, and showed the same accumulation of waste products in the cells seen in children with the genetic mutation. Blood tests also showed high levels of an inflammatory chemical called interferon gamma-induced protein 10 (IP-10) that is stimulated by interferons. The chemical is produced in response to some infections, and the group suspects that it also may be produced in the cellular stress response.

The discovery, which is described in Arthritis & Rheumatism, unifies several different diseases into one spectrum of proteasome-associated autoinflammatory syndromes, said Dr. Goldbach-Mansky. She hopes that these findings will enable doctors to identify more children who fit into this spectrum of difficult-to-treat disorders so that they can develop a better understanding of the disorders and their treatment.

Despite the best treatments currently available — which, in most cases, consist of high doses of steroids — children with these disorders continue to lose fat and suffer metabolic changes that lead to a range of problems, including loss of muscle mass, dilated heart muscles and cardiac arrhythmias. Treatments for other inflammatory diseases have little, if any, effect on the prognoses of these diseases. The group’s findings, however, suggest new therapeutic targets.

The researchers are currently setting up a clinical protocol that targets the interferon pathway. Physicians and parents who suspect a child may fit the criteria for CANDLE should contact Dr. Goldbach-Mansky's research group (Nicole Plass: at 301-496-2237 or plassn@mail.nih.gov).

The research was funded by the NIAMS Intramural Research Program and the Authority for Research and Development of the Hebrew University of Jerusalem. Additional support was provided by the National Human Genome Research Institute (NHGRI), the National Cancer Institute (NCI), and other institutions.

The researchers plan to collaborate with researchers in other institutes within NIH, including the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the NHGRI. They hope to learn more about the role of the gene mutation in CANDLE that leads to the disease symptoms, and to search for the genetic cause in those children who have only one disease gene, or no disease-causing mutation, so far.

The mission of the NIAMS, a part of the U.S. Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about the NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at http://www.niams.nih.gov/.

The NIDDK, a component of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see http://www.niddk.nih.gov/.

NHGRI is one of the 27 institutes and centers at the NIH, an agency of the U.S. Department of Health and Human Services. The NHGRI Division of Intramural Research develops and implements technology to understand, diagnose and treat genomic and genetic diseases. Additional information about NHGRI can be found at its website, http://www.genome.gov/.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at http://www.cancer.gov/ or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.

SUNDAY, Oct. 30 (HealthDay News) -- Children with asthma are at greater risk for flare-ups in the fall because of airborne ragweed and mold spores, as well as the flu and other seasonal infections, researchers warn.

Such flare-ups are marked by inflammation, swelling and tightening of the airways, resulting in wheezing, coughing and difficulty breathing. But, fortunately, it's possible to stave off these attacks, according to experts at the Johns Hopkins Children's Center.

"Year after year, we see a predictable spike in patient visits for asthma exacerbations in fall and winter, but many of these visits could be easily avoided with simple prevention," Dr. Robert Wood, director of allergy & immunology at Johns Hopkins Children's Center, said in a Hopkins news release.

Nearly 6.3 million children in the United States have asthma, making it the most common childhood chronic illness. However, the Hopkins experts said three key steps could help prevent flare-ups in these children:

Getting a flu shot. The flu and other respiratory infections can cause serious complications in children with asthma and other chronic conditions. The flu vaccine can prevent infections and minimize complications from the virus.

Avoiding asthma triggers. The best way to avoid asthma attacks is to avoid the triggers that cause them, including airborne allergens, cockroach and mouse allergens, industrial smog, household chemicals and bacterial and viral infections.

Using controller medications regularly. Children who experience asthma symptoms two or more times each week benefit from the regular use of controller medications, which suppress airway inflammation and prevent flare-ups.

"Over the summer, many patients have fewer asthma symptoms and cut down on their controller meds, but for most kids, symptoms will return with the change of season, so reverting to their regular drug regimens is critical," added Dr. Elizabeth Matsui, a pediatric allergist and immunologist at Johns Hopkins Children's Center, in the release.

By Kerry Grens
NEW YORK (Reuters Health) - People who have never smoked, but who live in areas with higher air pollution levels, are roughly 20 percent more likely to die from lung cancer than people who live with cleaner air, researchers conclude in a new study.

"It's another argument for why the regulatory levels (for air pollutants) be as low as possible," said Francine Laden, a professor at the Harvard School of Public Health, who was not involved in the research.

Though smoking is the number one cause of lung cancer, about one in 10 people who develop lung cancer have never smoked.

"Lung cancer in 'never smokers' is an important cancer. It's the sixth leading cause of cancer in United States," said Michelle Turner, the lead author of the study and a graduate student at the University of Ottawa.

Previous estimates of how many non-smokers get lung cancer range from 14 to 21 out of every 100,000 women and five to 14 out of every 100,000 men.

The fine particles in air pollution, which can irritate the lungs and cause inflammation, are thought to be a risk factor for lung cancer, but researchers had not clearly teased apart their impact from that of smoking.

In this study, Turner and her colleagues followed more than 180,000 non-smokers for 26 years. Throughout the study period, 1,100 people died from lung cancer.

The participants lived in all 50 states and in Puerto Rico, and based on their zip codes, the researchers estimated how much air pollution they were exposed to -- measured in units of micrograms of particles per cubic meter of air.

Pollution levels in different locations ranged from a low of about six units to a high of 38. The levels dropped over time, however, from an average of 21 units in 1979 - 1983, to 14 units in 1999 - 2000, producing an overall average pollution level of 17 units across the study period.

After the team took into account other cancer risk factors, such as second-hand smoke and radon exposure, they found that for every 10 extra units of air pollution exposure, a person's risk of lung cancer rose by 15 to 27 percent.

The increased risk for lung cancer associated with pollution is small in comparison to the 20-fold increased risk from smoking.

And the study team didn't prove that the pollution caused the cancer cases, but "there's lots of evidence that exposure to fine particles increases cardiopulmonary mortality," Turner told Reuters Health.

Fine particles in air pollution can injure the lungs through inflammation and damage to DNA, Turner's team writes in its report, published in the American Journal of Respiratory and Critical Care Medicine.

Previous research has suggested similar conclusions. A study of people in China, for example, found an increased risk of lung cancer attributed to indoor air pollution from burning coal and wood to heat homes (see Reuters story of December 7, 2009). And several European studies have linked levels of soot and vehicle exhaust to lung cancer in non-smokers.

Laden noted that the pollution levels associated with the increased risk of cancer in the current study are not uncommon in the U.S.

"These levels are within the (regulatory) standards," Laden told Reuters Health. "We're not talking about people who live in a really polluted place with no pollution control."

By Genevra Pittman
NEW YORK (Reuters Health) - The proportion of twins who are delivered by cesarean section in the U.S. has shot up "dramatically" since the mid-1990s, according to a new study.

While sometimes the babies' position or other delivery complications make a C-section necessary, California researchers reported that the largest relative increase in the practice was seen in healthy moms and babies who were well positioned to be delivered vaginally.

"There seems to be a very liberal approach to cesarean section with twins that has evolved over the last decade," said Dr. Mark Landon, the head of obstetrics and gynecology at Ohio State University in Columbus.

"The numbers are pretty dramatic in terms of the fact that three-quarters of twins undergo cesarean section now," Landon, who wasn't involved in the new study, told Reuters Health.

The 75 percent C-section rate in 2008, the most recent year covered in the study, is up from just over 53 percent in 1995.

That adds up to a five percent increase each year in the proportion of twins born via C-section nationwide.
And the trend couldn't be explained by an increase in complications, sicker moms or more "breech" babies positioned to be born feet-first.

Even in healthy women with the lowest risk of a delivery complication, and babies that were aligned head-first, the C-section rate increased from one-third of births at the beginning of the study period to more than half at the end.

In those cases, "there is really no evidence that cesarean delivery confers a benefit to either the mother or the infant, Landon said.

The findings, published in Obstetrics & Gynecology, are in line with other recent research suggesting that the C-section rate for all babies -- not just twins -- has been climbing. (See Reuters Health story of December 23, 2010).

Now, C-section deliveries account for about one-third of all births in the U.S.

Researchers have been unsure why that's the case. Some have suggested that obstetricians might be giving up on vaginal deliveries and switching to C-sections earlier in labor than they used to, or that more women are requesting C-sections so they can have greater control over when their babies are born.

But having a C-section raises a mother's risk of bleeding and infection, as well as bowel and bladder injuries.
The procedures also mean longer hospital stays and higher price tags.

"We know that sometimes they're appropriate and going to be beneficial... but in some instances there's no clear reason for them and it can potentially cause problems for the mother or baby," said Dr. Henry Lee from the University of California, San Francisco, who worked on the study.

And the increase in C-sections for twins, he told Reuters Health, "is not really explained by any kind of medical reason."

Lee said there needs to be more research on when C-sections are beneficial in dealing with twins, but his study suggests they're being done too frequently.

"It's a priority in our country now to decrease the cesarean rate overall," he concluded.

NEW YORK (Reuters Health) - Men who down more than four alcoholic drinks in a day may have a heightened risk of stomach cancer, a large European analysis suggests.

A number of studies have looked at whether people's drinking habits are related to their risk of stomach cancer, and come to mixed conclusions.

These latest findings, from a study of more than 500,000 European adults, suggest that heavy-drinking men are more likely to develop the cancer than light drinkers are.

At the start of the study, 10,000-plus men said they averaged more than four drinks per day. And their odds of developing stomach cancer over the next decade were twice those of light drinkers (who had the equivalent of about half a drink per day or less).

When the researchers looked more closely at the type of alcohol people consumed, they found that beer, in particular -- as opposed to wine or liquor -- seemed to be connected to stomach cancer risk.

There were no similar connections seen in women, according to the researchers, led by Dr. Eric J. Duell of the Catalan Institute of Oncology in Barcelona, Spain. But there were also far fewer heavy drinkers among the female participants (just under 2,300).

The findings, reported in the American Journal of Clinical Nutrition, do not prove that alcohol itself leads to stomach cancer in some men.

And the absolute risk for any one heavy drinker may be small. Of nearly 13,000 men and women who were heavy drinkers when they entered the study, just 33 developed stomach cancer over the follow-up period.

Still, experts already recommend that people who drink do so only in moderation. That generally means no more than two drinks per day for men, and no more than one for women.

Heavy drinking is linked to cancers of the mouth and throat, as well as other serious conditions like scarring of the liver.

Stomach cancer is relatively uncommon in the U.S. and other Western countries, though it's much more prevalent in other parts of the world, particularly developing nations. About 21,500 Americans will be diagnosed with stomach cancer this year, according to the American Cancer Society.

Smoking is one of the risk factors for the disease. And in some past studies, it's been hard to separate the possible effects of heavy drinking on stomach cancer from those of smoking -- since the same people often have both habits.

In the current study, though, Duell's team found that heavy drinking was linked to stomach cancer in men regardless of smoking habits.

The link also held when the researchers factored in people's diet habits (red and processed meats, for example, have been tied to stomach cancer) and any infection with H. pylori -- a type of bacteria that contributes to ulcers.

While most people with H. pylori do not develop cancer, persistent infection is thought to raise the risk of stomach cancer in certain people.

If heavy drinking is a cause of stomach cancer, it may be related to one of the metabolic byproducts of alcohol -- called acetaldehyde. The substance is a known human carcinogen, Duell's team notes.

On top of that, beer contains compounds known as nitrosamines, which cause cancer in animals. So it's possible, the researchers speculate, that the combination of those substances and acetaldehyde could explain why beer, in particular, was tied to stomach cancer in this study.

FRIDAY, Oct. 28 (HealthDay News) -- Men who consistently experience more than two stressful life events each year over an extended time period have a 50 percent higher mortality rate than their less-stressed peers, according to a new study.

Only three things seemed to help reduce the negative effects of this chronic stress: good health, marriage and the occasional drink.

"Being a teetotaler and a smoker were risk factors for mortality," lead study author, Carolyn Aldwin, a professor of human development and family sciences at Oregon State University, said in a university news release. "So perhaps trying to keep your major stress events to a minimum, being married and having a glass of wine every night is the secret to a long life."

The researchers examined stress patterns over the 18-year period from 1985 to 2003, and also documented stressors associated with older age groups, such as the loss of a spouse or coping with aging parents.

"Most studies look at typical stress events that are geared at younger people, such as graduation, losing a job, having your first child," Aldwin noted. "I modified the stress measure to reflect the kinds of stress that we know impacts us more as we age, and even we were surprised at how strong the correlation between stress trajectories and mortality was."

The study, published online in the Journal of Aging Research, surveyed nearly 1,000 middle- and working-class men in good health who originally had enrolled in the Boston VA Normative Aging Study in the 1960s.

Men who experienced an average of two or fewer major stressful life events per year were considered low-stress. Those in the moderate group had three major stressors while the men deemed as high-stress had up to six major life stressors each year.

The study found that the mortality risk for men in the moderate group was similar to that of the men in the high-stress group.

"It seems there is a threshold and perhaps with anything more than two major life events a year and people just max out," noted Aldwin in the release. "We were surprised the effect was not linear and that the moderate group had a similar risk of death to the high-risk group."

The authors noted that they also plan to investigate the effects of chronic daily stress as well as coping strategies.

"People are hardy, and they can deal with a few major stress events each year," concluded Aldwin. "But our research suggests that long-term, even moderate stress can have lethal effects."

FRIDAY, Oct. 28 (HealthDay News) -- Because many adolescents with mental health problems are never diagnosed and treated, an expert team has come up with a "toolkit" aimed at identifying those kids and getting them the right help.

"One in 10 youths have a mental health condition that is severe enough to impair functioning, either at home, school or in the community," said Gary Blau, chief of the child, adolescent and family branch of the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services.

Blau spoke at a Friday news conference to unveil the toolkit, which appeared online simultaneously in Pediatrics. Although the journal is published by the American Academy of Pediatrics, that organization has not endorsed the toolkit. SAMHSA provided partial funding for the project.

"This toolkit will allow pediatricians, teachers and others that could help get the word out to families we can close the gap so the three out of four children with mental health disorders who aren't identified do get identified," said Dr. Peter Jensen, who was the lead investigator on the project.

About half of mental health disorders manifest themselves by the time a child has turned 14, and 75 percent manifest by age 24, Blau said.

Yet treatment is often years away for that child, added Lisa Hunter Romanelli, an assistant professor of clinical psychology in psychiatry at Columbia University College of Physicians & Surgeons in New York City.

"That is too long in the life of a child," said Romanelli, who is also executive director of the nonprofit REACH Institute, whose mission is to shorten the length of time it takes for effective interventions to reach teens. Jensen is president and CEO of the institute.

Researchers convened over a period of several years to analyze data collected from more than 6,000 children and parents to identify the most common symptoms of mental health disorders and to see if children with these troubling signs were receiving appropriate care.

This information was then translated into warning signs that are written in "crisp, easy-to-understand language," said Jensen, who is vice chair of research in the department of psychiatry and psychology at the Mayo Clinic in Rochester, Minn. "They don't sound like mental health jargon. It was deliberate, to make them as parent-friendly as possible."

Because differentiating a true mental health disorder from the inevitable ups and downs of adolescence is difficult, the authors chose to focus on the more severe end of the mental health spectrum.

"We realized there was a potential for harm for parents to worry when they didn't need to be worried," said Jensen. "So we decided to target not the 15 percent or so who have these problems, but the 8 percent who are at the more severe end."

If your child has any of these 11 warning signs, he or she may have a mental health disorder and should be referred to treatment as soon as possible:

Feeling very sad or withdrawn for two or more weeks

Seriously trying to harm or kill themselves, or making plans to do so

Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing

Involved in multiple fights, using a weapon, or wanting badly to hurt others

Severe out-of-control behavior that can hurt the teenager or others

Not eating, throwing up, or using laxatives to lose weight

Intense worries or fears that get in the way of daily activities

Extreme difficulty in concentrating or staying still that puts a teenager in physical danger or causes school failure

Repeated use of drugs or alcohol

Severe mood swings that cause problems in relationships

Drastic changes in behavior or personality

"This data substantiates what we already knew, that there are warning signs of significant mental illness, but children and adolescents aren't getting help because health care providers don't share the same language," said Dr. Abigail Schlesinger, medical director of outpatient behavioral health services at Children's Hospital Pittsburgh.

"This toolkit will help mental health providers and others on the front lines, such as teachers, people in the juvenile justice system [and] parents speak the same language," added Schlesinger, who was not part of the research team.

FRIDAY, Oct. 28 (HealthDay News) -- A new study on living kidney donation finds that black donors are more likely to be related to their recipients than white donors are.

Understanding why such discrepancies exist could help reduce concerns about organ donation and assist in the development of specialized recruitment strategies for new donors, according to researchers at Wake Forest Baptist Medical Center, in Winston-Salem, N.C.

"African Americans are overrepresented in the dialysis population and they are underrepresented among those who receive living donor kidney transplants, the best option for long-term treatment of kidney disease," lead study author Dr. Amber Reeves-Daniel, medical director of the center's Living Kidney Donor Program, said in a news release. "The more we can understand what contributes to people's willingness to donate one of their kidneys, the better job we can do of educating potential living donors about the need and allay fears about the risks."

In conducting the retrospective study, researchers analyzed the medical records of 73 black and 324 white living kidney donors. The investigators found the black donors more often donated to family members -- blood relatives as well as in-laws. Meanwhile, white donors were more likely to be unrelated to the recipients of their organs.

The study, published online in the September/October issue of the journal Clinical Transplantation, also showed that most black donors were men and younger than their white counterparts. They were also more likely to give a kidney to their parents but slightly less likely to donate to their children.

"Adult African American dialysis patients are typically younger than white dialysis patients and this may explain, in part, why African American children are more often able to donate to their parents," Reeves-Daniel said in the medical center release.

The study authors added that more research investigating the cultural differences and family dynamics in kidney donation could help target recruitment strategies to both black and white donors.